By Jan Gurley, MD

The news that Dr. Marcus Conant has quit practicing medicine is a blow to healthcare here in the Bay Area.

And a sad symbol of all that is wrong with healthcare – and in particularly, the way we treat primary care practitioners – in America today. It would be hard to find a doctor more symbolic of the best of medicine than Marcus Conant – a man willing to devote his life to caring for people who, at the time, no one wanted to care for, a person who is a powerful advocate for not only his patients, but for all those affected by a devastating and stigmatizing disease, and a practitioner willing to devote himself to the tremendous amount of life-long-learning needed to not only transition into a lower paying field (from dermatology to primary care), but to stay up on developments as the stakes rose as treatment became vastly complex and life-changing.

But Marcus Conant is also, sadly, not an isolated case. More and more doctors have fled medicine. And more have fled California, in particular. The numbers are dwindling both due to dissatisfaction and justified retirement. Primary care practitioners – family practice docs, primary care docs, and internal medicine docs – are more and more only represented by an older generation of physicians who entered the field before the twin pressure of gutted pay and mega-hassles meant fewer and fewer sane people would choose it as a career.

So if you are one of the many whose doctor has given you the sad news that he/she is leaving the practice of medicine, what should you do?

1. Don’t delay – the number of people in the Bay Area who are taking new patients into primary care is shockingly small. When you add to that the restrictions that your insurance (if you’re lucky enough to have it) is likely to impose, plus the wait time for an appointment, you need to start working the phones.

Taking this step is surprisingly hard for many patients. Some of the reluctance may be due to a grief reaction, some may be due to a depression about starting all over again with another doctor (and airing all your issues – health and otherwise with a person you don’t yet know if you can trust). And part of it may be from past poor experiences with healthcare providers. If you tell yourself you may need to roadtest a few doctors before you find a good one, sometimes that can free you from thinking that first visit is an “all or nothing” high-pressure event.

2. Get your script down – your retiring doctor will likely be very happy to give you as many refills as possible on chronic meds, in order to help you buy time until you get a new provider. Be warned, however, that for some truly-important items (like pain meds), getting advance refills won’t be possible.

If this situation applies to you, ask your doctor frankly if there is a provider who can provide a transition role for you as you transfer your care. Even if such an arrangement is possible, patients with controlled pain medication needs are the ones who have to be most efficient about arranging a new doctor – hopefully one who will support your existing pain regime. No matter what your prescription needs are, don’t be fooled into thinking getting refills means you have more time to find a new doctor. You want to be fast out of the gate getting a new provider, and not fall into the trap of thinking more refills means you have more time – a change in your health status without a provider can leave you vulnerable to a truly bad outcome.

3. Get referrals sorted – it is a nasty surprise to most patients that an authorized referral to a specialist may not be covered by your insurance if your provider changes or leaves before you get to see the specialist. It was a nasty surprise to me (and you might think a doctor would know) when my personal dermatology appointment was denied reimbursement (I got socked with a tidy $300+ bill) NOT because the referral was inappropriate, and NOT because I didn’t follow all the correct steps.

It was denied because my provider left before dermatology could see me, and my “new” provider hadn’t written the referral. My “new” provider agreed it was an indicated referral, but that change-in-care was all an insurance company needed to deny payment. If possible, when you know your provider is retiring/leaving, do your best and enlist their help in getting specialty tests and referrals done prior to the leave date.

4. If you’re left hanging – with the aging primary care doctor population, and the high burnout rate in this field, many patients aren’t given much, if any, advance notice. Sometimes a sudden health crisis means you learn that your doctor is gone the day you show up for your appointment.

What can you do? First, get copies of all your health information. Then work the phones – including calling your insurance coverage to see about having your care transferred in a timely manner to available providers. Sometimes what is best is getting ANY healthcare provider, not necessarily the best. Once you’ve got someone to be your doctor, you can then look around for a better fit.

5. Grieving – you may be surprised at the amount of emotion you feel when your doctor leaves (whether he/she left by choice or not). Relationships with doctors, particularly those that have survived for many crisis, or years of health issue, as Dr. Conant’s patients undoubtedly experienced, can be more intense than we, as a society, often recognize. Give yourself time to grieve, and to remember. But don’t let those emotions keep you from getting a new provider. Fast.

Remember, your doctor will be grieving too – even if he/she chose to leave. No doctor makes that choice easily, or without some emotional fallout of their own. And he/she wants, more than anything, for you to be in the best of health.